Healthy weight wrest

Aiming for healthy
weight in wrestlers
and other athletes
By Vito A. Perriello, Jr., MD

Wrestlers and athletes in other
“weight-sensitive” sports are at high risk of engaging in unhealthy
weight-loss practices. Learning how to intervene effectively will help
you deal better with weight issues in all your patients.

U http://lose-weight.co.tv/
nhealthy weight loss and sports, unhealthy weight loss Pediatricians are more likely to
suboptimal nutrition, along practices are prominent in both encounter patients experiencing
with disordered eating habits sexes, with reported prevalences weight loss problems in wrestling
and eating disorders, are significant of 10% to 15% in boys and 25% to than in most other sports.
problems among adolescents. Seventy- 30% in girls.3,4 Other health issues associated
five percent of patients with dis- Weight-sensitive sports involve with wrestling, such as injury and
ordered eating develop the problem either a requirement to reach a spread of infection, put wrestling
during adolescence.1 specific weight or a perception in the fish bowl of public scrutiny.
Because 90% of eating disorders that an advantage exists if the This year, the National Fed-
occur in girls and women, most athlete performs at a lower eration of State High School Asso-
discussion in the literature focuses weight. Sports often cited for ciations, the governing body for
on this as a female problem. A having a high incidence of ath- high school athletics, recom-
1995 study of middle schools in letes engaging in unhealthy nu- mended to the wrestling rules
North Carolina, however, found trition and weight loss prac- committee that all states have
that, in addition to the 10% of tices include rowing, gymnastics, weight management programs in
girls in the sixth to eighth grades cross country, cheerleading, place for wrestling no later than
who reported using vomiting and dancing, and wrestling. Although 2004. Physicians across the coun-
laxatives to lose weight, 4% of many of the same concerns apply try may therefore be called upon
Wrestlers photographer: Jill Sabella/FPG International

boys reported similar practices.2 to all of these sports, this review to certify the minimum appropri-
Among athletes, especially those focuses on unhealthy weight loss ate weight for participation in
participating in “weight-sensitive” practices in wrestling for several wrestling, especially if a youngster’s
reasons: natural weight is below the recom-
THE AUTHOR is a general pediatrician in private
The magnitude of the weight loss mended minimum. Physicians
practice in Charlottesville, Va. He serves on the problem in wrestling is great and making these decisions for patients
Medical Advisory Committees of the Virginia High has been well-documented, with involved in wrestling and other
School League and the National Federation of studies reporting as many as 45% weight-sensitive sports need to be
State High School Associations. He is clinical
assistant professor of pediatrics, University of wrestlers at risk for a major familiar with techniques for deter-
of Virginia School of Medicine. eating disorder.5,6 mining body fat and appropriate

September 2001 CONTEMPORARY PEDIATRICS 55

WEIGHT AND WRESTLING

TABLE 1
weight management pro- Medical concerns more likely to try diuretics,
grams. This information also chromium, pyruvate, or
can provide a valuable tool associated with wrestling ephedrine (ma huang) to lose
for educating youngsters weight. [Editor’s note: For
Injuries
about nutrition, fitness, and more on supplements, see
healthy weight loss or gain, Wrestling ranks fourth in nonfatal catastrophic sports injury “Nutritional supplements
whether or not the youngster Wrestling ranks first or second in overall sports injury rate and the young athlete: What
participates in sports. you need to know” in the
Three wrestlers died from wrestling-related causes in 1998
July issue, also accessible
Health concerns Use of supplements at www.contpeds.com.]
in wrestling These substances have not
Alleged fat-burning supplements (more common
Wrestling has a long and in wrestling than in other sports) been shown to be effective,
storied history. Drawings of Ephedrine (ma huang) and their use presents sig-
wrestling holds have been nificant risks to young
found in Egyptian tombs Chromium athletes.
from 2,500 BC, and wrestling Pyruvate T h e g re a t e s t m e d i c a l
was one of the five sports in Androgenic supplements (less common in wrestling c o n cern associated with
the first Quadern Olympiad than in other sports) wrestling is the dangerous

http://lose-weight.co.tv/
in 776 BC. Participation in
wrestling has been shown to
contribute positively to self-
esteem, mental and physical
Creatine
Androstenedione
Spread of contagious disease
weight loss methods used by
many wrestlers. In 1998,
these behaviors led to the
deaths of three collegiate
toughness, self-discipline, wrestlers that were directly
Viral illnesses (rhinovirus, influenza)
and character. Despite these attributed to excessive weight
positive attributes, wrestling HIV infection/hepatitis (theoretical but not reported) loss.10
has suffered from the general Skin disease (herpes gladiatorum, impetigo,
perception that it is an un- tinea gladiatorum) What is fighting
healthy sport. The medical weight?
Inappropriate weight loss
literature substantiates this For most young athletes in all
perception to some extent. Excessive weight loss sports, the best weight at
Table 1 lists some of the Too rapid weight loss which to compete is the ath-
medical concerns associated Cycling of weight (repeated rapid loss and gain) lete’s natural weight, which is
with wrestling.7 In addition defined as out-of-season
to a high injury rate, the weight when eating and exer-
spread of infectious diseases, hepatitis B is not zero, it is extremely cising in a healthy manner. Studies
highlighted by documented epi- low, and no documented trans- suggest that a body fat percentage
demics of herpes gladiatorum, mission in the course of sports of 7% to 9% is efficient meta-
has long concerned the wrestling participation has been reported. bolically for most males. For most
community, and much work has The use of supplements in all females the most efficient and
been done on developing guide- sports is of concern to the sports healthy percentage is 12% to
lines for wrestlers’ return to medicine community. In contrast 15% body fat. 4,11 Attempts to
participation after developing skin to athletes in many other sports, achieve body fat compositions be-
diseases.8,9 Although the risk for who take supplements such as cre- low these percentages usually re-
spread of systemic contagious dis- atine or androstenedione to gain quire unhealthy eating practices.
eases such as HIV infection and weight and strength, wrestlers are No evidence exists to suggest any

56 CONTEMPORARY PEDIATRICS Vol. 18, No. 9


additional benefit in metabolic effi- myth that wrestling at a lower Losing weight too rapidly, losing
ciency or performance at lower weight for the same height improves an excessive amount of weight, and
levels. These percentages are con- leverage and provides an advantage frequent “cycling” of weight (rapid,
sidered the minimum for most per- over one’s opponent. Because it is repeated loss and gain), on the
sons and therefore are not neces- difficult to demonstrate how an ath- other hand, can undermine health
sarily the natural or ideal for a lete would have performed at differ- and well-being. Such unhealthy
given youngster. ent weights, no convincing data are patterns generally occur only if
Because of ethnicity or genetics, available to show whether perfor- water is lost—which can lead to
some youngsters’ natural weight mance is better or worse at lower dehydration—or “fat-free” tissue
may place them below the 7% weight classes. Wrestling at a lower (such as muscle) is lost because of
minimum body fat for males and weight class may also be motivated inadequate caloric intake. Neither
12% minimum for females. A by the desire to avoid competing type of weight loss benefits athletic
physician familiar with the youth against a wrestler in the athlete’s performance and, when carried
may be asked to verify that he or more natural weight class who is to extremes, can impair growth,
she is healthy and fit and can safely significantly better or to help the strength, and endurance.
participate at his or her present team fill an empty weight class slot. In female athletes, the triad of
weight even though body fat is be- Last, many in the wrestling commu- osteoporosis, amenorrhea, and
low the established minimum. The nity have developed a mentality of eating disorders, along with de-

physician should feel comfortable
certifying such a youngster for
participation if medical records
document a consistent pattern of
commitment, sacrifice, and self-
discipline that traditionally sees
weight loss as a critical component
of the “no pain, no gain” philosophy.
layed physical maturation, have
been linked to excessive weight
loss and sports participation at
weights below minimum natural
weight and no evidence of mal- weight.
nutrition or pathologic eating or When is losing weight Weight loss in prepubertal chil-
exercise behaviors. harmful? dren is an even greater concern if
Obviously, not all weight loss is not undertaken cautiously. Ex-
Why do wrestlers harmful. Anyone, including an cessive restriction of caloric in-
want to lose weight? athlete, can benefit from losing take and inadequate nutrition
Most athletes who want to lose body fat in certain circumstances. during growth can have an ad-
weight are motivated by a desire Excessive fat does not enhance an verse effect on adult height and
for improved appearance, better athlete’s performance, even in foot- health.
performance, or perceived compet- ball where coaches often seek out Two kinds of weight-loss prac-
itive advantage. Sports such as heavy players. It can hamper heat tices in wrestlers are cause for con-
wrestling, crew, and youth football acclimatization, speed, endurance, cern. One is loss of weight to a
require that teams or individuals and work efficiency. Weight loss level below what is considered
meet specific weight targets to par- can be beneficial if it involves losing healthy and appropriate (less than
ticipate. The drive to compete can excessive body fat without reducing 7% to 9% body fat for boys and 12%
encourage athletes to lose weight, lean muscle mass or causing signif- to 15% body fat for girls; weight loss
whether or not they have excessive icant dehydration. Healthy weight at a rate faster than 1.5% of body
body fat. loss requires eating a balanced diet weight or 2 lb per week is also con-
The major motivation for that supplies adequate calories to sidered unhealthy). The other is re-
wrestlers to lose weight is the hope support growth and daily activity peated cycling of weight throughout
of achieving greater success by com- and drinking enough fluid to the wrestling season. Cycling in-
peting in a lower weight class. This maintain an appropriate state of volves losing weight rapidly to
perception may be based on the hydration. “make weight” at a weigh-in for a



FIGURE 1

The ups and downs of weight cycling among wrestlers

160
159
155
155 154
Weight (lb)

150 152

145
145 145 145
140

135

Day 1 Day 8* Day 9 Day 15* Day 16 Day 22* Day 23

* Day of a match

“Cycles” of weight gain and loss during the wrestling season average 5 to 10 lb a week in many wrestlers, who lose weight rapidly to
“make weight” for a match, then gain back the lost pounds within a day afterward. Data on the graph have been compiled from multiple studies.

match, then eating and drinking af- weight is loss of body water by a renal blood flow, decreased glomer-
ter the match to compensate for nu- combination of fluid restriction and ular filtration rate, electrolyte im-
trition and fluid losses. Many excessive fluid loss. This method balance, and acidosis, which alters
wrestlers repeat this process for usually results in varying degrees cellular function throughout the
every match. Research has consis- of dehydration accompanied by body.
tently reported an average of 5 to the familiar physiologic changes: In addition to the familiar physi-
10 pounds of weight loss and gain hypovolemia leading to decreased ologic problems associated with de-
every week in such athletes. hydration, athletes demon-
The graph above summarizes strate two other worrisome
TABLE 2
the findings of a number of abnormalities resulting from
studies of average weekly Weight loss methods excessive weight loss and
weight loss among wrestlers.12 repeated cycling of weight:
As many as 80% to 93%
used by wrestlers abnormal thermoregulatory
of wrestlers use one or more Percent capabilities and decreased
of the measures to lose of wrestlers cardiac output. Thermoregula-
weight that are outlined in Method using tory abnormalities markedly
Table 2. 2,5,6,8,10,13,14 Many of Running, jogging 73% increase the threat of heat in-
these practices also occur to jury and severe dehydration
Exercise using a device (bicycle, jump rope, etc.) 59%
some degree i n o t h e r to poorly hydrated athletes
weight-sensitive sports. Rubber suit, nylon top 34% who are performing strenu-
Sauna 14% ous workouts because they
Dehydration and interfere with sweating and
other dangers Vomiting 8%
cooling of the body. The
The major method of rapid Spitting (to get rid of the weight of the saliva) 5% danger is actually greater
weight loss for athletes at- “Fat burner” devices (belts, etc.) 2% during a long practice work-
tempting to make a target out, which often occurs in a
Diuretics 2%



TABLE 3 increased heart rate and lethargy, resulting in lower
decreased stroke volume. grades during wrestling season.
Reported harm to wrestlers A high percentage of Some of these symptoms appear
from excessive weight loss unhealthy weight loss to be caused by hypoglycemia
occurs in smaller ath- from prolonged fasting as well
Academic performance letes and the lowest weight as dehydration.
Lethargy, sleepiness, mood swings
classes of wrestlers. 6 A lowered testosterone level,
Weight loss in the aver- decreased growth, and an in-
Lower grades during wrestling season (compared to age range of 5 to 10 lb creased incidence of disordered
out of season)
per week could repre- eating and eating disorders all
Diminished short-term memory and cognition sent a 5% to 10% level have been reported to result from
Athletic performance of dehydration in many the weight-loss practices of
of these athletes. Low wrestlers and other youngsters.
Lower testosterone level
cardiac output and ther- Horswell and colleagues have
Lower endurance moregulatory abnormal- shown that a 3% to 6% level of
Decreased strength on ergometric testing ities also pose a greater dehydration decreases strength
threat to younger and and endurance on ergometric
Altered body function
smaller athletes, who muscle measurement. 7,9,17 Thus,

Decreased growth
Increased susceptibility to infection
Decreased serum protein level
have greater body sur-
f a c e a re a f o r e v e r y
kilogram of weight.
Although many re-
besides being harmful to health, se-
vere weight loss is detrimental to
performance.

Lowered glycogen stores ports about health is- Effective weight
sues related to severe management
Decreased cardiac output and glomerular filtration rate
weight loss in athletes Most effective and safe weight
Poor temperature control with increased risk of heat injury
are anecdotal, recent management programs, whether for
Disordered eating data increasingly docu- wrestlers and other athletes in
Binge eating (6% of wrestlers meet criteria) 1 ment the adverse effects weight-sensitive sports or individu-
of excessive and fre- als attempting to lose weight for
Eating disorders (11% meet profile for eating disorders
on eating attitudes test [EAT]) 2 quent weight loss, espe- personal reasons, aim to minimize
cially among wrestlers unhealthy weight loss. Such pro-
REFERENCES
1. Oppliger RA, Landry GL, Foster SA, et al: Bulemic behaviors among
(Table 3). Similar prob- grams generally include a com-
interscholastic wrestlers: A statewide survey. Pediatrics 1993;91:826 lems have been reported prehensive nutrition and fitness
2. Garner DM, Olmsted MP, Bohr Y, et al: The eating attitudes test: Psycho- in nonathletes who ex- component that attempts to edu-
metric features and clinical correlates. Psychol Med 1982;12(4):871
perience frequent swings cate athletes, parents, and coach-
in body weight.16 es about the dietary requirements
warm wrestling room, than in a An increase in academic diffi- needed to support growth, activ-
match, which lasts six minutes or culties has been noted among ities of daily living, and the in-
less.15 young athletes whose food and creased nutritional requirements
Another significant threat is de- fluid consumption is inadequate. of sports. Another important com-
creased cardiac output, which can Unlike most athletes, who tend to
produce strain on the heart even earn better grades during sports
The patient guide on the next pages about
with minimal exertion. Cardiac participation, wrestlers are likely
▲

healthy weight loss can be photocopied
output drops when reduced blood to experience poor focus and con- and distributed to families in your practice
volume from dehydration leads to centration, mood swings, and without permission of the publisher.


GUIDE FOR PATIENTS

Steps to healthy weight loss
T here are no short cuts to losing weight effectively of calories burned can vary to some degree depending
and safely. Weight gain and loss are directly
related to the balance between the calories you take
on your weight and how long and intensely you
exercise. The minimum calorie requirements
in and the calories you burn through daily activity suggested here support only usual daily activities.
and specific exercise, such as sports. You must consume additional calories if you participate
A government-sponsored task force recently in aerobic activities such as athletics, dancing, or
reviewed the multimillion-dollar industry of fad diets strenuous work.
that guarantee quick weight loss using everything Teenagers need to eat a balanced diet that consists of
from vibrators to pills. The task force concluded that carbohydrates (55%), fat (20% to 25%), and protein
although some of the diets may contribute to weight (15% to 20%). Teens who are healthy and eating a good
loss, none maintains weight loss (keeps weight off diet do not need nutritional supplements. Eating a high-
once you lose it). Eating less fat
(meat, cheese, and whole milk,
for example) and more complex Minimum daily calorie needs at desired weight
carbohydrates (bread, cereal, 3,500

pasta), along with regular
aerobic activity, appears to offer
the best hope for losing weight
3,000

2,500 • •
• •
•

• •
and keeping it off.
Losing excess body fat
• •
Calories

2,000
should be your only goal in
losing weight. Losing water or 1,500
•
fat-free tissue, such as muscle,
is not desirable or healthy and 1,000
does not improve performance 500
or appearance.
0
Eat right 100 110 120 130 140 150 160 170 180 190
Most adolescents need 1,700 to Weight (lb)
3,000 calories a day just to meet
physiologic needs and support
growth and normal daily activities. The minimum carbohydrate meal four to six hours before a sports
number of calories varies somewhat based on size, competition can improve performance and well-being.
as shown on the graph at right. Don’t forget to drink enough water, which is
An average 30-minute period of aerobic exercise, the most important nutrient, making up 60% of the
such as jogging, burns about 350 calories; an intense body. During exercise, you should drink 1⁄2 cup
two-hour sports practice can burn more than 1,000 to 1 cup of water every 15 to 30 minutes
calories. The table on the next page shows about how depending on the heat index and the intensity
many calories various activities consume. The number of the exercise.
This Guide for Patients may be photocopied and distributed without permission to give to your patients and their parents. Reproduction for any other purpose requires express
permission of the publisher. Copyright © 2001 Medical Economics Company.


GUIDE FOR PATIENTS/STEPS TO HEALTHY WEIGHT LOSS

Calories burned
by various activities
Calories burned
Activity in 60 min*
Aerobic dancing 470
Backpacking (carrying a 40-lb pack) 670
Badminton 440 produce energy. This undermines strength and
Basketball 630 endurance.
Bicycling (10 mph) 450 Get enough exercise
Circuit weight training 420 Adequate exercise, along with moderately reducing
Cross-country skiing 650 the number of calories you consume, promotes the
Racquetball 800 most efficient loss of fat while preserving fat-free
tissue. The minimum amount of aerobic activity
Rope jumping 775
necessary to benefit from this efficient fat loss is
Running (7 mph) 880 30 minutes three times a week of an exercise that
Swimming (slow crawl) 600 burns about 350 calories in one workout.
Volleyball 228 Studies suggest that you must burn 3,500 calories to
lose one pound of fat. You can therefore lose 1 or 2 lbs
Walking
of fat a week by burning 500 to 1,000 more calories a
3.5 mph 350
day than you take in. (Remember: Burning more than
4 mph (with 5-lb hand-held weights) 590

Chores http://lose-weight.co.tv/
4 mph (with 5-lb ankle weights)

Digging ditches
540

660
500 to 1,000 calories beyond what you take in leads
to loss of fat-free tissue and is undesirable.)

Maintain your “natural weight”
Mowing (push or power mower) 510 You should strive to maintain a “natural weight.”
Sawing with a hand saw 550 Natural weight is your weight when you are eating
Weeding 330 a healthy, balanced diet with enough calories to
*Values vary based on intensity of activity and weight. Values shown here
are for a 167-lb person.
sustain growth and usual daily activities and
getting 30 minutes of aerobic exercise at least three
times a week. Your doctor can help you determine
Avoid “semistarvation” diets—those in which your natural weight and body fat composition
the number of calories you consume during a (what percentage of your weight consists of fat).
24-hour period is more than 500 to 1,000 below For most boys (with some variation), the normal
the number of calories you burn. Deficits greater range of body fat composition is 7% to 20%. A body
than 500 to 1,000 calories usually result in very fat composition of 10% to 15% is considered
limited additional loss of fat and promote loss of excellent. For most girls (again, with variation), the
water and some fat-free tissue (muscle). Most acceptable body fat range is 12% to 25%. A range of
people on such diets tend to regain weight 15% to 20% is ideal. Abnormally high body fat
quickly. composition can lead to health problems such as
Severely reducing the number of calories you high blood pressure, a high cholesterol level, heart
take in causes your body to lose large amounts of disease, diabetes, and gall bladder disease.
water, electrolytes (substances such as sodium Too little body fat, like too much, can be bad for your
and potassium), and minerals. In addition, the health. Body fat below 7% for boys can interfere with
body looks for sources of energy other than fat growth, strength, and endurance. Body fat below 12%
and finds it in muscle and glycogen (carbohydrate for girls can be associated with problems such as missed
stored mostly in the liver), which it then uses to menstrual periods, weak bones, and eating disorders.



TABLE 4 in weight, history of poor eating
habits, or concerns about weight.
Measuring body fat They can add credence and objectiv-
ity to discussions with youngsters
Method Comment and their parents about healthy
Underwater weighing Expensive, limited access; gold standard weight management practices.
Many methods of determining
Skin-fold calipers (Lange/Harpenden) Closest to underwater weighing in accuracy;
body fat are available; underwater
validated; reasonable cost
weighing is considered the gold
Dual energy X-ray absorptiometry (DEXA) Expensive and not validated for youth standard. Table 4 lists a number of
Bioimpedance (Tanita) Expensive and not validated for youth; easy to use other techniques used to determine
body density, percent body fat, and
Near-infrared photospectometry (Futrex) Expensive and not validated for youth; calculates
other body composition measure-
many other body nutritional parameters
ments (body density is part of the
Computerized calipers (Skydex) Contain the wrong formula for adolescents formula used to calculate percent
Air displacement weighing (BOD-POD) Not validated for youth body fat). The only method that has
been validated for high-school–age
CT scans Expensive method of measuring fat
youngsters, and the one that most

ponent of proper weight manage-
ment is determining body fat and
calculating the minimum recom-
weight management programs.19,20
The task force also encourages
an increase in the number of
closely reproduces the results of the
expensive and fairly inaccessible
method of underwater weighing, is
measurement of skin-fold thickness
mended participation weight, wrestling weight classes and/or with fat calipers.21 For information
which is based on 7% body fat for participation by multiple wrestlers on how to use this method and how
most boys and 12% body fat for in the more popular weight classes to calculate minimum weight, see
most girls. A third component in- as a means of addressing this issue “How to measure body fat,” pages
volves educating the athlete nationwide. 72 and 73. With a little experience
about the maximum weight loss and the aid of precalculated charts
each week that can be achieved in How can pediatricians kept on hand in your examining
a healthy manner.18 (See the pa- help? room, you can measure body fat us-
tient guide, “Steps to healthy weight One role of pediatricians and other ing the skin-fold method in less
loss,” pages 65 and 66.) primary care physicians is to mon- than a minute.
Discouraging wrestlers from itor the health and nutrition of all In Virginia, body-fat measure-
bouncing from low weights for our patients, especially during ments are now part of the standard
match weigh-ins to higher weights health maintenance or prepartici- preparticipation physical examina-
between matches has been the pation sports physical examination form, which has introduced
most difficult aspect of weight tions. That makes it important to the idea of fitness to athletes, par-
management. The 1996 American be familiar with body fat measure- ents, and physicians.22,23 While I
College of Sports Medicine (ACSM) ments, minimum weight calcula- have been more reluctant to deter-
position statement on weight loss tions, height-weight proportions, mine body fat routinely on female
in wrestlers and a subsequent res- and normal growth curves. athletes than male athletes because
olution by the ACSM wrestling Body fat measurements can be of the potential for precipitating
task force emphasize the im- helpful in primary care practice for weight concerns and disordered
portance of addressing this issue monitoring health and nutrition in eating, it can be a helpful and posi-
and outline desirable features of patients with a significant change tive part of the physical evaluation



How to measure body fat
B ody fat measurement is the best tool for establishing
suitable weight targets. This is the case because fat
is the most desirable body component to decrease to
SUBSCAPULAR (boys and girls)
• Locate the inferior angle, lowest point of the scapula.
If this is not palpable with the arms at the side, ask the
achieve weight loss. Studies have shown that, with a patient to put the arm behind the back.
little practice, skin-fold measurement can be a very • Mark a
accurate technique for determining body fat and diagonal line
calculating a healthy weight goal. Good quality skin below the scapula
calipers, such as the Lange calipers, are inexpensive, that is an
durable, and easy to use. Once you are familiar with the extension of the
methodology and have created a chart or computer natural hollowing
program to calculate body fat from skin-fold measurement, of the skin. This
the entire procedure can be done in one or two should be on an
minutes. axis from the left X
Following are instructions for marking the three most shoulder to the
commonly used sites for skin-fold measurement, some right hip, which
general rules for measuring skin folds, and formulas for is approximately
calculating body density, body fat, and minimum a 45° angle from
weight at 7% and 12% body fat. The modified Lohman the vertical. Draw

equation is the most accurate formula for high school
boys. A modified Slaughter-Lohman-Boileau equation is
used for girls.
a mark perpendicular to that line 1 cm below the
inferior angle.
• When raising the skin fold for measurement have the
patient stand with his arm hanging relaxed at his side.
Marking skin folds
TRICEPS (boys and girls) ABDOMINAL (boys only)
• Have the patient stand with the right arm flexed • Have the patient
to 90° at the elbow and relaxed. stand relaxed on
• Determine the both feet and relax
midpoint between the abdominal
the acromial process of muscles.
the shoulder and the •Mark a vertical line
olecranon of the elbow 3 cm to the right of
and make a horizontal the midpoint of the X
mark there. umbilicus.
• Make a vertical mark • Draw a horizontal
to intersect this line line to intersect the
over the triceps muscle vertical line 1 cm below the midpoint of the umbilicus.
X in the midline of the
posterior arm. General rules
• For the actual caliper for measuring skin folds
measurement, have the • Have the patient stand with weight evenly
patient stand with the distributed on both feet and the arms relaxed and
arm straightened and hanging down at his sides in the normal standing
relaxed. position. For the abdominal measurement, have the
patient relax the abdominal muscles.
• For consistency, always take the measurement on
the right side of the body.


• Make sure the skin is dry to facilitate accurate • If the first two measurements are not within 0.5 mm
measurement. of each other, take a third measurement and average the
• Do not take a measurement immediately after a two that are within 0.5 mm. If no two are within that
workout or when the patient is overheated because range, average the three recorded measurements for
elevated body temperature causes fluid shifts to the that site.
skin, resulting in a falsely elevated reading.
• Palpate the site to familiarize yourself and the Calculating body fat
youngster with what is to happen. The formulas for calculating body density, body fat,
• “Pinch” the skin and subcutaneous tissue only and minimum weight at 7% body fat (boys) or 12%
(not muscle) between the finger and thumb firmly body fat (girls) are listed below. (Body density must
(but not firmly enough to cause pain) about 1 cm be determined first because it is part of the formula
above the intersecting lines you have drawn as for calculating body fat.) USA Wrestling is planning
described above. The pinch should be parallel to the to post interactive spreadsheets on its Web site
natural cleavage lines of the skin (the natural (www.usawrestling.org) that allow you to insert
cleavage lines of the skin of the triceps, for example, weights and skin-fold measurements to calculate
would be vertical rather than horizontal across the all the desired information. To obtain your own
arm). Excel spreadsheet, contact Jon Almquist at
• Apply the calipers at the intersecting marks JLAACT@aol.com.

perpendicular to the long axis of the skin folds and
midway between the body skin surface and the bulbous
crest of the skin fold.
• Allow the calipers to equilibrate for two to four
For counseling about healthy weight gain and loss
in general pediatric practice, using the patient’s
measured weight in the equations below provides
acceptable accuracy. To determine minimum weight
seconds before taking the readings. for wrestling, where athletes often “push the
• When taking readings, be careful to look directly at envelope,” the NCAA and NFHS recommend
the calipers to avoid parallax, resulting in an inaccurate documenting a urine specific gravity of 1.020 or less
reading. before weighing the athlete to ensure that he is
• Record measurements on data sheets to the nearest adequately hydrated. Otherwise, the weight shown
0.5 mm. on the scale will represent a dehydrated weight that
• Rotate measurements from one site to the next is lower than the athlete’s actual weight and allow
(triceps to subscapular to abdominal in boys) and then a lower minimum weight determination than is
take a second round of measurements. considered appropriate and safe.

BOYS ONLY GIRLS ONLY
Lohman equation for calculating body density (BD) Slaughter-Lohman-Boileau equation for calculating
Sum SF* = Triceps SF + subscapular SF + abdominal SF % body fat (BF)
BD = [1.0973 - (sum SF x .000815)] + Sum SF = Triceps SF + subscapular SF =
[(sum SF)2 x .00000084] % BF = [(sum SF ) x 1.33] - [(sum SF)2 x .013] - 2.50 =
% BF
Brozek equation for calculating % body fat (BF)
% BF = (4.57/BD - 4.142) x 100 Calculating minimum weight at 12% BF
Weight at 12% BF = [1 - (% BF/100)] x currrent weight
Calculating minimum weight at 7% BF
0.88
Weight at 7% BF = [1 - (% BF/100)] x current weight
0.93
* SF = Skin-fold measurement



if handled in a sensitive manner the risks and benefits of various weight use potentially harmful methods to
and presented in the proper con- loss methods practiced by young achieve an excessive amount or
text (for example, as part of weight athletes and about how to achieve a rate of weight loss. In general,
management counseling for girls safe rate and amount of weight loss. weight loss in adolescents and, es-
who express concerns about weight Regrettably, many surveys have pecially, prepubertal youngsters is
or girls with menstrual irregular- shown that wrestlers and other ath- not advisable unless excessive body
ities that appear to be caused by letes hardly ever consult physicians fat is documented.
inappropriately low weight). on these subjects. We need to take a Pediatricians have an important
New growth curves are now avail- more active role in discussing nutri- role to play in educating parents and
able from the Centers for Disease tion and fitness at check-ups and, youngsters about nutrition, body
Control and Prevention (www.cdc. especially, at the preparticipation fat, and the role of exercise and diet
gov/growthcharts) or Ross Products sports physical examination. in healthy weight loss and gain.
Division of Abbott Laboratories Those who are familiar with quick,
(Columbus, OH 43215-1724). The Toward sensible accurate methods of determining
new charts reflect present growth weight control body fat and know how to prescribe
standards for youngsters in this In our society, a significant number a healthy weight management pro-
country and include 3rd and 97th of adolescents attempt to lose gram for patients can provide valu-
percentile lines. They also include di- weight for a variety of reasons. able guidance at health mainte-

rections for calculating body mass in-
dex, which makes them very useful
for accurately determining whether
a youngster is overweight or under-
Many of these youths, whether
they participate in sports or not,

REFERENCES
nance check-ups and preparticipation
physical evaluations. □

weight. [Editor’s note: For more on 1. Kreipe RE: Eating disorders among children and 12. Perriello VA: How Wrestlers can Achieve Victory and
adolescents. Pediatr Rev 1995;16:370 Enjoyment While Maintaining a Healthy Diet. Virginia High
this topic, see “Understanding 2. Krowchuk DP, Kreiter SR, Woods CR, et al: Problem School League Publication, October 1994
growth patterns in short stat- dieting behaviors among young adolescents. Arch Pediatr 13. Oppliger RA, Harns RD, Herrmann DE, et al: Grappling
Adolesc Med 1998;152:884 with weight cutting. Physician and Sports Medicine 1995;
ure” in the June issue, also 3. Perriello VA: Virginia High School League Training 23:69
accessible at www.contpeds.com.] Workshop on Wrestling Weight Management for Master 14. Parr RB: Exercise for overweight kids. Physician and
Testers, Fall 1999 (available from Vito A. Perriello, Jr., MD, Sports Medicine 1998;26:109
When monitoring weight and nu- c/o Larry Johnson, Virginia High School League 1642 State 15. Montain S, Coyle E: Influence of the timing of fluid in-
trition in young athletes, the pedia- Farm Boulevard, Charlottesville, VA 22901) gestion on temperature regulation during exercise. J Appl
4. Ashley CD, Smith JF, Robinson JB, et al: Disordered Physiol 1993;75:688
trician must know what sports the eating in female collegiate athletes and collegiate females in 16. National Task Force on Prevention and Treatment of
patient plays, understand the role of an advanced program of study. Int J Sport Nutr 1996;6:391 Obesity: Weight cycling. JAMA 1994;272:1196
5. Steen SN, Brownell KD: Patterns of weight loss and re- 17. Roemmich J, Sinning W: Weight loss and wrestling
weight in sports, and be familiar gain in wrestlers: Has the tradition changed? Med Sci Sports training: Effects on nutrition, growth, maturation, body
with some of the myths and tradi- Exerc 1990;22:762 composition, and strength. J Appl Physiol 1997;82:1751
6. Perriello VA, Almquist J, Conkwright D, et al: Health 18. Oppliger RA, Landry GL, Foster SW, et al: Wisconsin
tions regarding weight gain or loss in and weight control management among wrestlers. Virginia minimum weight program reduces weight-cutting practices
various sports. One of the biggest Medical Quarterly 1995;122:179 of high school wrestlers. Clin J Sport Med 1999;99:929
7. Cantu RC, Meller FO: Fatalities and catastrophic injuries 19. Opplinger RA, Case S, Horswill CA, et al: American
weight management problems oc- in high school and college sports 1982–1995. Physician College of Sports Medicine position stand: Weight loss in
curs when, for example, a high and Sports Medicine 1999;27:35 wrestlers. Med Sci Sports Exerc 1996;28(6):ix
8. Anderson BJ: Effectiveness of valocyclovir in preventing 20. Case HS, Horswill CA, Landry G, et al: Weight Loss in
school football coach sees a young- reactivation of herpes gladiatorum in wrestling. Clin J Sport Wrestlers. Current Comment from the American College of
ster as a 185-lb linebacker and only a Med 1999;9:86 Sports Medicine. January 1998
9. Medical Advisory Committee to National Federation of 21. Kuta JM, Clark RR, Webber LM, et al: Inter- and intra-
few days after football season ends, High School Associations: Physician release for wrestlers to tester reliability of skin fold measurements in high school
the wrestling coach sees that same participate with skin lesions. Indianapolis, NFHS (PO Box wrestlers. Med Sci Sports Exerc 1990;22:S110
690, Indianapolis, IN 46206), 1999 22. Perriello VA: Virginia’s athletic exam form: Results and
athlete as a 152-lb state wrestling 10. Three college wrestling deaths. MMWR 1998;47:105/ revisions. Virginia Medical Quarterly 1992 (summer);
champion. JAMA 1998;279:824 119:159
11. Clark RR, Oppliger RA: Minimal weight standards in 23. Perriello VA, Almquist J, Pitrezzi M, et al: New medical
Physicians must do a better job of high school wrestling, the Wisconsin model. Orthopedic standards for Virginia’s high school athletes. Virginia
educating parents and patients about Physical Therapy Clinics of North America 1998;7:23 Medical Monthly 1989;116:359


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